Banic A, Sigurdsson G H, Wheatley A M
Department of Plastic and Reconstructive Surgery, University of Berne, Inselspital, Switzerland.
Microsurgery. 1995;16(7):469-75. doi: 10.1002/micr.1920160707.
Hypovolemia and hypotension in traumatized patients as well as those undergoing long-lasting surgical procedures lead to hypoperfusion of tissues. Combined with the trauma of flap elevation and the warm ischemia during performance of the anastomoses, hypoperfusion of flap tissues may lead to flap failure. The influence of hypovolemia, ischemia and reperfusion on flap macro- and microcirculation was studied in an acute experiment on a new musculocutaneous pectoralis flap developed in minipigs. Using a multichannel laser Doppler system we studied, simultaneously and continuously, microcirculatory flow (MBF) in both the skin and muscle of the flap as well as in the contralateral control skin and muscle in anesthetized minipigs (n = 7). Measurements were done before and after raising the flap, after 90 min of flap ischemia, during mild to moderate hypovolemia (5%, 10%, 15%, and 20% blood loss) and during and after restoration of blood volume. Electromagnetic flowmetry was used to measure total blood flow (TBF) to the flap. All animals remained hemodynamically stable during the experiment. The flap MBF decreased by 20% in the skin and 25% in the muscle after flap elevation with no changes in the control skin and muscle. After flap ischemia and reperfusion, MBF returned to post-elevation values while TBF showed a significant increase as compared to MBF (P < 0.05). Hypovolemia caused a gradual drop in cardiac output (25%) and mean arterial pressure (40%), but both recovered above the baseline after reinfusion of shed blood. Hypovolemia also caused a 60% reduction in MBF in both flap skin and muscle, and only 20-23% in control skin and muscle (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
创伤患者以及接受长时间外科手术的患者出现的低血容量和低血压会导致组织灌注不足。再加上皮瓣掀起的创伤以及吻合术过程中的热缺血，皮瓣组织灌注不足可能导致皮瓣坏死。在一项急性实验中，我们对小型猪新开发的胸大肌肌皮瓣进行研究，观察低血容量、缺血和再灌注对皮瓣宏观和微观循环的影响。我们使用多通道激光多普勒系统，在麻醉的小型猪（n = 7）身上，同时连续地研究皮瓣皮肤和肌肉以及对侧对照皮肤和肌肉的微循环血流（MBF）。测量在掀起皮瓣前后、皮瓣缺血90分钟后、轻度至中度低血容量（失血5%、10%、15%和20%）期间以及血容量恢复期间和之后进行。使用电磁血流计测量皮瓣的总血流（TBF）。实验过程中所有动物的血流动力学均保持稳定。掀起皮瓣后，皮瓣皮肤的MBF下降了20%，肌肉下降了25%，而对照皮肤和肌肉无变化。皮瓣缺血和再灌注后，MBF恢复到掀起后的水平，而TBF与MBF相比显著增加（P < 0.05）。低血容量导致心输出量逐渐下降（25%）和平均动脉压下降（40%），但回输失血后两者均恢复到基线以上。低血容量还导致皮瓣皮肤和肌肉的MBF降低60%，对照皮肤和肌肉仅降低20 - 23%（P < 0.01）。（摘要截短至250字）
